Regional Patterns - Sweden

Cost of dementia

by Anders Wimo, Karolinska Institutet and Linus Jönsson, I3 Innovus

In a report from the National Board of Health and Welfare in Sweden, the number of demented and the societal costs of dementia was estimated for 2005 (1). This report is an update of a previous report regarding 2000 (2).

Demented persons in Sweden can get care in several care alternatives. Basically, demented has access to formal medical and non medical care and informal care in their own homes or in institutions, although at a small amount, there is also some informal care in institutions (15).

It was estimated that the number of demented had increased from 133,000 to 142,200 between 2000 and 2005. The societal costs included costs of institutional care, social services at home, day care, medical care at home, hospital care, visits to physicians and other types of medical staff, emergency care, drugs, and informal care. Due to a decrease in the number of institutional beds (from about 120,000 beds 10 100,000 beds), the number of institutionalized demented had decreased from 75,000 (56% of the demented in 2000) to 64,500 (45% of the demented in 2005) (table 1).

Table 1. Distribution of the Swedish dementia population in 2005

Per cent

Proportion of demented

Number of persons

At home

55%

77,700

Institution

All institutional care

45%

64,500

- Nursing home

75%

22,500

- Group Living

100%

23,000

- Other institutional care

40%

19,000

All

142,200

The estimate of the contribution of informal care and home care services was based on a Swedish cohort study (3) where the realation between the severity of dementia and the amount of care in terms of hours were assessed (table 2).

Table 2. Informal and formal care at home (hours per day (3)..

Informal care

Formal care

Severity of dementia

Total informal care

PADL and IADL

Supervision

Mild

2.1

1.4

0.7

0.7

Moderate

8.3

1.6

6.7

1.2

Severe

16.0

4.9

11.1

1.5

All

5.8

1.8

3.9

1.0

Different methods were partly used for the cost of illness estimates but if the same costing approach was used for both years, the total societal costs had increased from 49.6 billion SEK to 50.1 billion SEK (5.3 and 5.4 billion € respectively) but since the number of demented was larger, the costs per demented person had decreased from 373,000 SEK in 2000 to 352,000 SEK in 2005 (about 40,000 and 38,000 € respectively) (table 3).

Table 3. The total societal costs of dementia in Sweden in 2005(base option)

SEK (millions)*

County councils

Hospital care

775

Emergency room visits

164

Out care visits (specialists)

147

Primary care visits

286

Other out care

229

Drugs

790

Diagnostics (incidence)

202

Total county councils

2,594

Municipalities

Institutional care

33,454

Day care

419

Home services

8,604

Total municipalities

42,478

Informal care

4,642

Indirect costs

383

TOTAL

50,097

Per demented (SEK)

352,300

*discrepancies due to rounding

The municipalities had by far the greatest economic burden. The net costs were estimated to be about 75% of the societal gross costs. There was a close relationship between the severity of cognitive decline, from 64,000 SEK (6,900 €) with no cognitive decline) to 420,000 SEK (45,000 €) in severe cognitive decline. The costs of informal care was estimated with a conservative approach in the base option, but depending on costing and quantification approach of informal care in the sensitivity analysis, the proportion of the costs of informal care varied from about 10% to 50% of the total societal costs. The main reason for the decrease in the societal costs per demented was the decrease in the number and proportion of institutionalized demented. The societal costs of dementia were also compared to Swedish cost of illness studies regarding other diseases. The societal costs of dementia were the highest but close to the costs of dementia were costs of psychiatric disorders (exclusive dementia) and rheumatic disorders, indicating that economic burden of chronic long lasting disorders. The costs of these disorders were higher than the costs of cancer, diabetes and cardiovascular disorders.

Acknowledgements

The EuroCoDe project received financial support from the European Commission. Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. Alzheimer Europe also gratefully acknowledges the support it received from Fondation Médéric Alzheimer for this project.